Provider Demographics
NPI:1639925456
Name:SHIBA, LORIE PATRICE (IBCLC)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:PATRICE
Last Name:SHIBA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 DOLORES LN APT B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3341
Mailing Address - Country:US
Mailing Address - Phone:714-287-6008
Mailing Address - Fax:
Practice Address - Street 1:16661 DOLORES LN APT B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3341
Practice Address - Country:US
Practice Address - Phone:714-287-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-33720174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN